<!DOCTYPE html>
<html lang="en">

<head>
    <meta charset="UTF-8">
    <meta name="viewport" content="width=device-width, initial-scale=1.0">
    <meta http-equiv="X-UA-Compatible" content="ie=edge">
    <link rel="stylesheet" href="../../common/reset.css">
    <link rel="stylesheet" href="css/smrzxx_zrr.css">
    <link rel="stylesheet" href="../../plugs/layui/css/layui.css">
    <script src="../../common/jquery.min.js"></script>
    <script src="../../plugs/layui/layui.js"></script>
    <script src="js/smrzxx_zrr.js"></script>
    <title>Document</title>
</head>

<body>
    <form class="layui-form" action="">
        <div class="layui-form-item">

            <div class="wxn_sm_name">
                <span>姓名</span>
                <div class="layui-inline">
                    <input type="text" name="title" placeholder="请输入姓名" autocomplete="off" class="layui-input">
                </div>
            </div>

            <div class="wxn_sm_sfzh">
                <span>身份证号</span>

                <div class="layui-inline">
                    <input type="text" name="title" placeholder="请输入身份证号" autocomplete="off" class="layui-input">
                </div>
            </div>

            <div class="wxn_sm_phone">
                <span>手机号码</span>

                <div class="layui-inline">
                    <input type="text" name="title" placeholder="请输入手机号码" autocomplete="off" class="layui-input">
                </div>
            </div>


        </div>
    </form>

    <div class="wxn_sm_cjsfzxx">
        <div class="wxn_sm_cjsf_t">
            实名认证信息采集： (可到税务机关采集实名认证图像)
        </div>
        <ul class="wxn_sm_sfphoto">
            <li class="f_left">
                <div class="wxn_sm_rmx">
                    人面像
                </div>
                <div class="wxn_sm_rmxk">
                    <div class="wxn_sm_modal">
                        <div class="wxn_btn_primary">上传</div>
                        <form enctype="multipart/form-date" method="post">
                            <input type="file" class="file">
                        </form>
                    </div>
                    <img src="" class="fileImg">
                </div>
            </li>
            <li class="f_left">
                <div class="wxn_sm_rmx">
                    国徽面
                </div>
                <div class="wxn_sm_rmxk">
                    <div class="wxn_sm_modal">
                        <div class="wxn_btn_primary">上传</div>
                        <form enctype="multipart/form-date" method="post">
                            <input type="file" class="file">
                        </form>
                    </div>
                    <img src="" class="fileImg">
                </div>
            </li>
            <li class="f_left">
                <div class="wxn_sm_rmx">
                    手持照
                </div>
                <div class="wxn_sm_rmxk">
                    <div class="wxn_sm_modal">
                        <div class="wxn_btn_primary">上传</div>
                        <form enctype="multipart/form-date" method="post">
                            <input type="file" class="file">
                        </form>
                    </div>
                    <img src="" class="fileImg">
                </div>
            </li>
        </ul>
    </div>
    <div class="wdl_sm_btn">
        <p class="wxn_btn_primary f_left wxl_bg_lan1">提&nbsp;&nbsp;&nbsp;&nbsp;交</p>
        <p class="wxn_btn_primary f_left wxl_bg_red">取&nbsp;&nbsp;&nbsp;&nbsp;消</p>
    </div>
</body>

</html>